Comparison of the results of preoperative assessment of cardiovascular risk and outcomes of surgical interventions for locally advanced abdominal cancer

Abstract

This retrospective study analyzed the structure of complications and mortality cases in 351 patients (men, n = 199; women, n = 152) aged 33–89 years with locally advanced abdominal cancer and different cardiovascular risks in the early postoperative period, and two patient groups were formed. The main group consisted of 81 (23.1%) patients who died in the early postoperative period. The comparison group included 270 (76.9%) patients. In total, 311 (88.6%) patients underwent radical surgical intervention, whereas 40 (11.4%) underwent minimally invasive surgical treatment. Perioperative cardiovascular risk was stratified by calculating cardiac risk indices and using the database of the National Program for Improving the Quality of Surgical Care — Myocardial Infarction and Cardiac Arrest. Fatal complications in the early postoperative period after surgical treatment of locally advanced abdominal cancer is significantly more often observed in patients with a more pronounced degree of tumor invasion, lymph node lesions, high class according to the standards of the American Society of Anesthesiologists, reduced functional status, prior hormone therapy, and combined anesthesia. The majority of fatal cases were associated with three complications, i.e., ventricular arrhythmias (53%), acute decompensation of heart failure (46%), and multiple organ failure (43%). Approximately 95% of deaths were associated with increased postoperative cardiovascular risk, and 52% were medium-risk cases. Hospital mortality at low risk was noted in 4.9%, average in 27.8%, and high in 32.7% of the patients. In cases with a favorable course, surgical complications were predominant over cardiovascular ones. The use of calculated cardiac risk indices and database of the National Program for Improving the Quality of Surgical Care — Myocardial Infarction and Cardiac Arrest confirmed their high ability to predict the development of cardiovascular complications, which are the leading causes of death in the early postoperative period in patients who underwent surgical interventions for locally advanced abdominal cancer.

Keywords

cardiovascular risk / non-cardiac operations / hospital mortality / perioperative complications / myocardial infarction / oncological diseases of the abdominal cavity / surgical treatment / cardioncology

References

[1] Sostoyanie onkologicheskoi pomoshchi naseleniyu Rossii v 2019 godu. Kaprin AD, Starinskij VV, Shahzadova AO, Eds. Moscow: MNIOI im. P.A. Gercena – filial NMIC radiologii; 2020. 239 p. (In Russ.)

[2] Состояние онкологической помощи населению России в 2019 году / ред. А.Д. Каприн, В.В. Старинский, А.О. Шахзадова. Москва: МНИОИ им. П.А. Герцена – филиал НМИЦ радиологии, 2020. 239 с.

[3] Kotova DP, Kotov SV. Features of postoperative complications of a therapeutic profile during surgical interventions of various categories of complexity. Lechebnoe Delo. 2020;3:52–59. (In Russ.). DOI: 10.24412/2071-5315-2020-12257

[4] Котова Д.П., Котов С.В. Особенности послеоперационных осложнений терапевтического профиля при проведении оперативных вмешательств разной категории сложности // Лечебное дело. 2020. № 3. С. 52–59. DOI: 10.24412/2071-5315-2020-12257

[5] Zabolotskikh IB, Trembach NV, Musaeva TS, et al. Possibilities of preoperative assessment of the risk of an adverse outcomes after abdominal surgery: preliminary results of the multicenter stoprisk study. Annals of Critical Care. 2022;4:24–35. (In Russ.). DOI: 10.21320/1818-474X-2020-4-12-27

[6] Заболотских И.Б., Трембач Н.В., Магомедов М.А., и др. Возможности предоперационной оценки риска неблагоприятного исхода абдоминальных операций: предварительные результаты многоцентрового исследования STOPRISK // Вестник интенсивной терапии им. А.И. Салтанова. 2020. № 4. С. 12–27. DOI: 10.21320/1818-474X-2020-4-12-27

[7] Protasov KV, Bolshedvorskaya OA. Myocardial injury after non-cardiac surgery: current state of the problem and unresolved issues. Russian Journal of Cardiology. 2019;(11):122–132. (In Russ.) DOI: 10.15829/1560-4071-2019-11-122-132

[8] Протасов К.В., Большедворская О.А. Повреждение миокарда после внесердечных операций: современное состояние проблемы и нерешенные вопросы // Российский кардиологический журнал. 2019. Т. 24, № 11. С. 122–132. DOI: 10.15829/1560-4071-2019-11-122-132

[9] The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators. Association between complications and death within 30 days after noncardiac surgery. CMAJ. 2019:191(30):830–837. DOI: 10.1503/cmaj.190221

[10] The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators. Association between complications and death within 30 days after noncardiac surgery // CMAJ. 2019. Vol. 191, No. 30. Р. 830–837. DOI: 10.1503/cmaj.190221

[11] International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth. 2016;117(5):601–609. DOI: 10.1093/bja/aew316

[12] International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries // Br J Anaesth. 2016. Vol. 117, No. 5. Р. 601–609. DOI: 10.1093/bja/aew316

[13] Kristensen S, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014;35(41):2873–2926. DOI:10.1093/eurheartj/ehu281

[14] Kristensen S., Knuuti J., Saraste A., et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management // Eur Heart J. 2014. Vol. 35, No. 41. P. 2873–2926. DOI: 10.1093/eurheartj/ehu281

[15] Herrmann J. From trends to transformation: where cardio-oncology is to make a difference. Eur Heart J. 2019;40(48):3898–3900. DOI: 10.1093/eurheartj/ehz781

[16] Herrmann J. From trends to transformation: where cardio-oncology is to make a difference // Eur Heart J. 2019. Vol. 40, No. 48. P. 3898–3900. DOI: 10.1093/eurheartj/ehz781

[17] Khorana AA, DeSancho MT, Liebman H, et al. Prediction and Prevention of Cancer-Associated Thromboembolism. Oncologist. 2021;26(1):2–7. DOI: 10.1002/onco.13569

[18] Khorana A.A., DeSancho M.T., Liebman H., et al. Prediction and Prevention of Cancer-Associated Thromboembolism // Oncologist. 2021. Vol. 26, No. 1. P. 2–7. DOI: 10.1002/onco.13569

[19] Sokolov DA, Lyuboshevsky PA, Staroverov IN, et al. Posthospital cardiovascular complications in patients after non-cardiac surgery. Messenger of Anesthesiology and Resuscitation. 2021;18(4):62–72. (In Russ.). DOI: 10.21292/2078-5658-2021-18-4-62-72

[20] Соколов Д.А., Любошевский П.А., Староверов И.Н., и др. Постгоспитальные сердечно-сосудистые осложнения у больных, перенесших некардиохирургические операции // Вестник анестезиологии и реаниматологии. 2021. Т. 18, № 4. С. 62–72. DOI: 10.21292/2078-5658-2021-18-4-62-72

[21] Bedzhanyan AL. Surgical treatment of cancer in the elderly with concomitant cardiovascular pathology. Clinical and Experimental Surgery. Petrovsky Journal. 2020;8(4):35–42. (In Russ.). DOI:10.33029/2308-1198-2020-8-4-35-42

[22] Беджанян А.Л. Хирургическое лечение онкологических больных пожилого и старческого возраста с сопутствующей сердечно-сосудистой патологией // Клиническая и экспериментальная хирургия. Журнал имени академика Б.В. Петровского. 2020. Т. 8, № 4. С. 35–42. DOI: 10.33029/2308-1198-2020-8-4-35-42

[23] Imaev TE, Komlev AE, Akchurin RS, et al. Cardiovascular surgery in cancer patients - a new challenge for hybrid surgery. Cardiovascular Therapy and Prevention. 2019;18(4):99–104. (In Russ.). DOI:10.15829/1728-8800-2019-4-99-104

[24] Имаев Т. Э., Комлев А. Е., Акчурин Р. С. Хирургия сердца и сосудов у онкологических больных – новый вызов гибридной хирургии // Кардиоваскулярная терапия и профилактика. 2019. Т. 18, № 4. С. 99–104. DOI: 10.15829/1728-8800-2019-4-99-104

[25] Malkova MI, Bulashova OV, Khazova EV, et al. Personalized approach to perioperative risk assessmentin patients with cardiovascular diseases in emergency care clinic. The Bulletin of Contemporary Clinical Medicine. 2018;11(5):62–68. (In Russ.). DOI: 10.20969/VSKM.2018.11(5).62-68

[26] Малкова М.И., Булашова О.В., Хазова Е.В. Персонифицированный подход к оценке периоперационного риска у пациентов с сердечно-сосудистой патологией в клинике неотложной помощи // Вестник современной клинической медицины. 2018. Т. 11, № 5. С. 62–68. DOI: 10.20969/VSKM.2018.11(5).62-68

[27] Dzhioeva ON, Drapkina OM. Postoperative atrial fibrillation as a risk factor for cardiovascular complications in non-cardiac surgery. Cardiovascular Therapy and Prevention. 2020;19(4):2540. (In Russ.). DOI: 10.15829/1728-8800-2020-2540

[28] Джиоева О.Н., Драпкина О.М. Послеоперационная фибрилляция предсердий как фактор риска сердечно-сосудистых осложнений при внесердечных хирургических вмешательствах // Кардиоваскулярная терапия и профилактика. 2020. Т. 19, № 4. С. 112–118. DOI: 10.15829/1728-8800-2020-2540

[29] Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery: Developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) Endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC). Eur Heart J. 2022;43(39):3826–3924. DOI: 10.1093/eurheartj/ehac270

[30] Halvorsen S., Mehilli J., Cassese S., et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery: Developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) Endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC) // Eur Heart J. 2022. Vol. 43, No. 39. P. 3826–3924. DOI: 10.1093/eurheartj/ehac270

[31] Jammer I., Wickboldt N., Sander M., et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol. 2015;32(2):88–105. DOI: 10.1097/eja.0000000000000118

[32] Jammer I., Wickboldt N., Sander M., et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures // Eur J Anaesthesiol. 2015. Vol. 32, No. 2. P. 88–105. DOI: 10.1097/eja.0000000000000118

[33] Davis C, Tait G, Carroll J, et al. The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients. Can J Anesth. 2013;60(9):855–863. DOI: 10.1007/s12630-013-9988-5

[34] Davis C., Tait G., Carroll J., et al. The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients // Can J Anesth. 2013. Vol. 60, No. 9. Р. 855–863. DOI: 10.1007/s12630-013-9988-5

[35] Cohn S, Fernandez Ros N. Comparison of 4 cardiac risk calculators in predicting postoperative cardiac complications after noncardiac operations. Am J Cardiol. 2018;121(1):125–130. DOI: 10.1016/j.amjcard.2017.09.031

[36] Cohn S., Fernandez Ros N. Comparison of 4 cardiac risk calculators in predicting postoperative cardiac complications after noncardiac operations // The Am J Cardiol. 2018. Vol. 121, No. 1. Р. 125–130. DOI: 10.1016/j.amjcard.2017.09.031

[37] Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth. 2017;119(3):553. DOI: 10.1093/bja/aew472

[38] International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries // Br J Anaesth. 2017. Vol. 119, No. 3. P. 553. DOI: 10.1093/bja/aew472

[39] Khoronenko VE, Chissov VI, Suvorin PA, et al. Perioperative prophylaxis of venous thromboembolism in routine oncosurgery. Research and Practical Medicine Journal. 2016;3(4):61–69. (In Russ.). DOI:10.17709/2409-2231-2016-3-4-7

[40] Хороненко В.Э., Чиссов В.И., Суворин П.А., и др. Периоперационная профилактика венозных тромбоэмболических осложнений в плановой онкохирургии // Исследования и практика в медицине. 2016. Т. 3, № 4. С. 61–69. DOI: 10.17709/2409-2231-2016-3-4-7

[41] Izmailov AG, Dobrokvashin SV, Volkov DE, et al. The concept of prevention and treatment of postoperative wound complications in surgical patients. Practical Medicine. 2017;(6(107)):50–54. (In Russ.).

[42] Измайлов А.Г., Доброквашин С.В., Волков Д.Е., и др. Концепция профилактики и лечения послеоперационных раневых осложнений у хирургических больных // Практическая медицина. 2017. № 6 (107). С. 50–54.

[43] De Hert S, Staender S, Fritsch G, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery. Eur J Anaesthesiol. 2018;35(6):407–465. DOI: 10.1097/eja.0000000000000817

[44] De Hert S., Staender S., Fritsch G., et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery // Eur J Anaesthesiol. 2018. Vol. 35, No. 6. Р. 407–465. DOI: 10.1097/eja.0000000000000817

[45] Kotvitskaya ZT, Kolotova GB, Rudnov VA, et al. Intraoperative risk factors for myocardial infarction during cardiac surgery. Messenger of Anesthesiology and Resuscitation. 2018;15(2):32–37. (In Russ.). DOI: 10.21292/2078-5658-2018-15-2-32-37

[46] Котвицкая З.Т., Колотова Г.Б., Руднов В.А., и др. Интраоперационные факторы риска развития инфаркта миокарда при некардиохирургических вмешательствах // Вестник анестезиологии и реаниматологии. 2018. Т. 15, № 2. С. 32–37. DOI: 10.21292/2078-5658-2018-15-2-32-37

[47] Kozlov IA, Ovezov AM, Pivovarova AA. Reduction of risk of perioperative complications in case of cardiac comorbidity. Messenger of Anesthesiology and Resuscitation. 2020;17(2):38–48. (In Russ.). DOI: 10.21292/2078-5658-2020-17-2-38-48

[48] Козлов И.А., Овезов А.М., Пивоварова А.А. Снижение риска периоперационных осложнений при кардиальной коморбидности // Вестник анестезиологии и реаниматологии. 2020. Т. 17, № 2. С. 38–48. DOI: 10.21292/2078-5658-2020-17-2-38-48

[49] Kotova DP, Kotov SV, Gilyarov MYu, et al. Prediction score in surgical complications estimation in the practice of internist. Cardiovascular Therapy and Prevention. 2018;17(2):75–80. (In Russ.). DOI: 10.15829/1728-8800-2018-2-75-80

[50] Котова Д.П., Котов С.В., Гиляров М.Ю., и др. Использование прогностических шкал в оценке периоперационных осложнений в практике врача-терапевта // Кардиоваскулярная терапия и профилактика. 2018. Т. 17, № 2. С. 75–80. DOI: 10.15829/1728-8800-2018-2-75-80

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